Many different risk factors can increase the likelihood of a young person having suicidal thoughts or attempting to die by suicide. While most parents and counselors are familiar with the potential impact that bullying and depression can have on the likelihood of a teen attempting death by suicide, there is also another danger that may not be so apparent. Emerging research indicates that a teenager who has suffered a traumatic brain injury (TBI) may have a greater risk of taking his or her own life.

Mental health professionals need to be aware of factors that increase a teen’s likelihood of death by suicide and must act to protect their patients. A suicide attorney should be consulted in situations where a mental health counselor has potentially failed to live up to his obligations with teens.

The Link Between TBI and Suicidal Thoughts or Attempts

According to Psych Central, a traumatic brain injury can result in “significantly greater odds” that a teenager will make an attempt. This is true even if the TBI was a simple concussion. Teens with a TBI had three times the chances of attempting suicide, and twice the chances of being bullied either at school or online.

Researchers identified this link by reviewing data collected as part of the 2011 Ontario Student Drug Use and Health Survey. The survey initially began as a method of studying drug use but has been broadened to ask questions about adolescent well-being and health. It is one of the longest ongoing school studies worldwide and almost 9,000 students participate. The students range from grade seven to grade 12.

In 2011, questions about traumatic brain injury were added to the study for the first time. Prior research shows that as many as 20 percent of adolescents in Ontario had experienced a TBI over the course of their lives.

The comprehensive nature of the new study allowed for connections to be drawn between a history of TBI and an attempt to die by suicide.  Mental health experts know that TBIs can exacerbate both mental health and behavioral problems, so it is important to understand this link.

Research revealed that a teenager who had a prior TBI was more likely to become a bully or to be bullied; and was also more likely to have been prescribed medication for anxiety, for depression or both. Teens with a prior TBI also had greater odds of breaking and entering; selling drugs; running away from home; damaging property; getting into fights at school; carrying weapons and setting fires.

Because of the far-reaching consequences of a TBI, prevention should always be the top goal, especially as many traumatic brain injuries are suffered during recreational or athletic activities and could be prevented by the use of helmets.

Unfortunately, once a brain injury has occurred, the only option is to watch carefully for signs of problems. It is essential for “primary physicians, schools, parents, and coaches” to be vigilant in monitoring adolescents who have suffered a brain injury.  Counselors should also provide the assistance these teens need to cope and avoid behavioral problems or thoughts of suicide.

A suicide attorney at the Law Offices of Skip Simpson can help. Call (214) 618-8222 to schedule a free case consultation.

If your loved one is about to be admitted to a psychiatric hospital because he or she is suicidal, this is a blog you should print out and take with you to the hospital. It could save your loved one’s life.

When a loved one is in the hospital, we assume that the care is high quality and, most of all, safe. We feel relieved that our loved one is finally being properly protected while he or she is enduring a suicidal crisis.  We expect constant and safe round-the-clock trained nurses or psychiatric techs properly watching our loved ones to make sure all is well. We expect a properly trained psychiatrist giving hospital staff proper orders to protect our loved ones. We expect hospital leadership working hard to make the hospital safe.

Sadly, inpatient suicide—when a person takes his own life in a hospital or kills herself in a healthcare facility—is all too common. In fact, inpatient suicides occur six times a day every day of the year.

This is particularly egregious because the reason the patient is hospitalized is to keep the patient safe from suicide.

Sadly, unless hospitals abide by proper safety rules, the psychiatric hospital can be dangerous for suicidal patients … not as dangerous as not being hospitalized, but the hospital danger is a needless danger.  The mental health literature has clearly set forth safety rules for psychiatric hospitals for over 20 years, but many hospitals are turning a blind eye to the lessons of the literature primarily because of greed. There are obvious exceptions like Johns Hopkins in Baltimore, but the exceptions are rare.  The hospitals do not want to spend money on properly training staff or making sure the hospital is environmentally safe for a suicidal patient.  In addition, hospitals are understaffed so that the nurses and techs cannot keep up with properly protecting their patients.

What Families Can Do to Foster Suicide Prevention Awareness

Texas suicide lawyer Skip Simpson knows how vulnerable certain patients can be during their stay in a healthcare facility due to improper suicide watch and broken safety rules. He believes it is important for families to be aware of the statistics in order to foster as much suicide prevention awareness as possible.

Suicidality is the most common reason for inpatient psychiatric hospitalization. When a patient is admitted to the hospital because of thoughts of suicide, the clinician and hospital is on notice that the patient is at an increased risk for suicidal behavior. To be extra clear, the hospital knows it is likely a suicidal patient will attempt suicide in the hospital if the patient is not properly protected.

When hospital staff members are aware of a patient’s suicidal risks, the hospital assumes the duty to take reasonable steps to prevent the patient from inflicting harm. Obviously if the hospital staff does not know the proper safety rules or does not want to spend the money to learn them, the “reasonable steps” concept is ditched and the chief executive and finance officer just hopes for the best … just rolls the dice with patient safety.

An inpatient suicide may occur under varying types of circumstances. These circumstances all relate to violations of safety rules from inadequate suicide assessment, negligent suicide watch, an unsafe environment, inadequate policies and procedures regarding dangerous contraband like shoe laces or belts (to mention only a few).

What can the loved one do when their loved one is being admitted to a hospital for protection from suicide?

1) Make sure hospital staff knows exactly what your loved one has said about suicide or what steps your loved one has taken towards ending his or her life. You can ask your loved one before getting to hospital if he or she has thought about suicide. If yes, ask how he thought about doing it. Ask what steps he or she has taken, like buying a gun, getting a rope, hoarding pills, thinking of jumping from a bridge, or jumping in front of a car.

Make sure the hospital staff knows the answers to these questions.  Why? Because you cannot be sure hospital staff will ask them!

Make sure you see staff document what you say.

2) Ask who will be assessing your loved one for suicide and what their qualifications are to do so.  Don’t be embarrassed to be proactive. Be nice but be firm. You want your loved one protected…the more you are showing your concern the more concern your loved one will receive hopefully.

3) Tell the staff you want to be a part of the treatment team.  If there is a decision about your loved one’s care you want to be a part of that decision.

4) Encourage your loved one to sign a waiver of confidentiality so you can be kept informed by the staff of what your loved one is saying about suicide.  Patients often demand to be released and claim they are not suicidal so they can get out of the hospital…frequently so they can attempt suicide. Pressing for discharge can be a risk factor for suicide.

5) Tell staff you want to know what was learned in the suicide risk assessment. You may be able to shed light on what your loved one is telling the psychiatrist or nurse.  There are many reasons why your loved one may not “tell all” and your knowledge can make a big difference.

6) Determine how often the psychiatrist will visit with your loved one in the hospital.  Tell the psychiatrist you would like a brief call updating you on your loved one’s condition and the plans for your loved one.

7) Determine what level of observation your loved one will be on. In other words, will he or she be watched constantly? If not, how often? If you are told your loved one will be watched every 15 minutes, remind the staff that if your loved one attempts suicide by hanging, it only takes 2-3 minutes to have irreversible brain damage and 6-7 minutes to be dead.  Then ask, “How 15 minutes is protective?” Again, be firm and be an advocate for your loved one. The hospital patient’s advocate is employed by the hospital. You are the only true advocate for your loved one.

8) Ask if there is a bathroom door inside the patient’s room. If so this is where patients hang themselves using a sheet or clothing to hang over the door wrapped as a noose.

9) Ask how often your loved one will be properly assessed for suicidal thinking.

10) Ask how the staff monitors for behavioral signs and symptoms of suicide.

11)  If the staff or psychiatrist wants to relax suicide precautions to less than constant tell the staff you want to be notified to discuss this with staff.  You will want to know if there has been significant, stable, and reliable change in your loved one to warrant a step down in protection. Remind the staff that hanging is the number one way patients die by suicide in a hospital. Remind staff that ordinarily this is done in the privacy of the patient’s room or bathroom.

12) If a staff member acts rude with you or to your loved one, insist to see the staff member’s supervisor and explain you concern. Suboptimal staff-patient relationships are a risk factor for suicide. You want your loved one to have hope and not to feel like he is a burden or no one cares.

13)  When it comes time for discharge from the hospital, again make sure you are part of the discharge process. If you don’t feel like your loved one is ready for discharge say so and tell staff why. Again, make sure you see staff document your disapproval in the chart.

If staff insists on discharging your loved one ask to speak to the CEO of the hospital. If all else fails, call 911 and report that your loved one who you believe is still suicidal is being discharged from a psychiatric unit.

14) If you feel your loved one is safe for discharge make sure your loved one’s transition to outpatient care is smooth and immediate. Why? Post discharge of psychiatric patients admitted to a hospital for suicidal protection, is a very dangerous high risk time for a suicide attempt.

15) Very important: Make sure all guns are removed from your home, your car (check carefully under the seats, glove compartment, trunk… think like a police officer who is checking for drugs), your relatives and friends homes and cars, and anywhere in sheds or other hiding places around the home or apartment.   Skip Simpson, in making this list, has handled cases where guns were hidden and used post discharge.

16) Ask hospital staff how many suicides have occurred in the hospital in the last 5 years. Get an answer from someone.

17)  Ask staff what they do to ensure the hospital is safe for your loved one.  Do they have suicide prevention committee meetings? Do they utilize a Failure Mode and Effect Analysis? This analysis thinks of ways that patients could suicide in a hospital and fixes what needs to be fixed before a suicide occurs.

Patients, Families Suffer When Safety Rules Are Ignored by Hospitals

The hospital has lots of patients. You have one loved one who needs protecting. Make sure your loved one is on the top of the hospital’s list to protect.

The suicide prevention literature makes the who, what, where, why and how of inpatient suicide very clear. There is no guess work in making psychiatric hospitals safe.  When the safety rules are not followed, only the patients and their loved ones suffer the consequences.  Not the financial statement of the hospitals or the hospital leaders.

If you lost a loved one due to inpatient suicide, you may be able to pursue insufficient suicide watch compensation or recover damages for suicide in a hospital. For a free and confidential consultation, contact a tough yet understanding lawyer who can help you seek the justice you deserve. Contact Skip Simpson Attorneys and Counselors by calling 214-618-8222 or completing online contact form.

How many times, when you were extremely anxious, depressed, overwhelmed, and suicidal, did you call your primary care physician after hours? Remember the recording, “If this is an emergency, call 911 or go to your nearest emergency room?”  You muster up the courage to go to the Emergency Room, only to endure a wait, perhaps for hours. You might conclude the wait is making you more stressed and leave (wrong choice) or you might wait to be seen by the ER staff. Is the ER staff competent to help?  Maybe not. If you are overwhelmed will you need a family member or a friend to help you negotiate the ER? Absolutely.

Emergency rooms are recognized as an important component of suicide prevention … if the ER is competently staffed. Studies indicate that on average 412,000 ER visits per year are related to intentional self-harm or suicide attempts. Thousands more go the ER seeking help for mental health concerns including increased anxiety, depression, and thoughts of suicide. Many visits to the ER are by folks who have not yet attempted suicide but are in a suicidal crisis and need an intervention to prevent an attempted suicide. Now for the rub.

For effective treatment to occur in the ER, the ER staff must detect, assess, and manage the suicide risk before suicidal individuals choose that most desperate and final act. In those situations in which suicidal people have made it to the emergency room, most of us believe they are safe and will be protected.  Not so! Most emergency room staff, including the doctors, are poorly trained – or not trained at all – in the detection, assessment, management, and treatment of suicidal persons.

Steps to Take to Get the Help You Need

A recent report in Academic Emergency Medicine, the official journal for the Society for Academic Emergency Medicine, concludes “…suicide screening for adults in the [emergency department] (ED) is far from universal, which is concerning as many individuals at risk for suicidal behavior seek treatment in the ED.” The report states that many patients presenting with suicide risk factors were not screened for suicide. In a nutshell, a suicidal patient is going to need assistance from a friend or loved one in the ER to enhance the chances of the patient getting better help.

What can you do to get the help you need?

1. First understand that the ER may not be as good as we would like it in assessing and treating suicidal patients, but it is clearly the best choice when there is a suicidal crisis.  The likelihood is that if you, and your loved one or friend follows these steps, the ER, with your help, will make better decisions.
2. If you are suicidal, tell a family member or friend you are having suicidal thoughts and need help. Tell the family member or friend you would like them to take you to the emergency room. Trying to handle a suicide crisis without professional help is like flying a plane without a license.
3. After you arrive at the ER tell the first person working at the ER you see that you are suicidal and need help and now.
4. If you are a friend or family member helping the suicidal patient, make sure the ER staff knows your friend or loved one is suicidal and needs help now.
5. Make sure you see the intake person write in the records that the presenting patient is stating they are suicidal and needs help. If they don’t write it in the charts, ask them to do so. ER staff will have second thoughts on prematurely discharging a patient when the records state the patient is suicidal and thinking of killing themselves if not helped.
6. Make sure the intake nurse knows clearly the last time you thought about suicide and what it is you thought. If you thought about shooting yourself, say so. If overdosing, say so. If hanging yourself, say so. If you are helping the suicidal patient make sure you understand the answers to these questions and tell the intake nurse if the patient does not.
7. Understand that the point of this exercise is to get the protection you need. If protected and the underlying reasons for the suicidal thinking are properly treated with the correct counseling and medication, things WILL get better.
8. If the ER staff makes the suicidal patient wait in the ER, make sure you don’t let them leave the waiting room if possible. Don’t be afraid to speak out loud and clear if the suicidal patient is leaving. Silence or being embarrassed to speak out could be a deadly decision.  Remember you are with your spouse, child, or friend for a reason: getting them help & keeping them safe.
9. If the ER staff makes a decision to discharge the suicidal patient, ask the staff if they assessed the patient for suicide.
10. Ask the staff why they think the patient is safe?
11. Ask the staff if the patient can safely be left alone?  If the answer is no, ask why not?  Get the name of the ER staff member who says your loved one or friend is safe. Ask the staff member for a safety plan. Insist on the safety plan.
12. If you don’t get a safety plan ask to speak to the ER physician for an explanation of why no plan?
13. Ask the staff for the specific reason your loved one is not being admitted inpatient. If admitted they will likely only be in the hospital for 3-5 days … a small price in time to have many more years of life.
14. Listen to the reasons for not admitting inpatient. If you believe your loved one or friend is in danger for hurting themselves if not helped, tell the staff why you think that. Again, tell the staff to record in the patient’s records your concern.
15. Remember the squeaky wheel gets the oil.
16. Patients and their loved ones and friends can’t count on the ER to get it right.  You must make it clear, even to the untrained, that your loved one and friend need to be properly assessed and managed.

At the Law Offices of Skip Simpson, we understand how devastating it is to lose a family member or friend to suicide. If you lost a loved one, you will need a compassionate lawyer who works hard to hold mental health professionals accountable. Contact a Dallas attorney with a highly successful track record who represents clients nationally. Call 214-618-8222 or fill out our online contact form.